Folliculotropic mycosis fungoides with large‐cell transformation presenting as dissecting cellulitis of the scalp

Follicular mycosis fungoides (MF) is a rare variant of cutaneous T‐cell lymphoma (CTCL) in which malignant lymphocytes preferentially infiltrate hair follicles. This report describes a patient with follicular mycosis fungoides presenting in a manner similar to dissecting cellulitis of the scalp with...

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Bibliographic Details
Published in:Journal of cutaneous pathology 1997-03, Vol.24 (3), p.169-175
Main Authors: Gilliam, Anita C., Lessin, Stuart R., Wilson, Darren M., Salhany, Kevin E.
Format: Article
Language:English
Subjects:
Adult
Biological and medical sciences
Cell Transformation, Neoplastic - pathology
Cellulitis - pathology
Folliculitis - pathology
Hair Follicle - pathology
Hematologic and hematopoietic diseases
Humans
Leukemias. Malignant lymphomas. Malignant reticulosis. Myelofibrosis
Lymphoma, Large B-Cell, Diffuse - pathology
Male
Medical sciences
Mycosis Fungoides - pathology
Scalp Dermatoses - pathology
Skin Neoplasms - pathology
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Summary:Follicular mycosis fungoides (MF) is a rare variant of cutaneous T‐cell lymphoma (CTCL) in which malignant lymphocytes preferentially infiltrate hair follicles. This report describes a patient with follicular mycosis fungoides presenting in a manner similar to dissecting cellulitis of the scalp with nonhealing, draining nodular lesions. Follicular mucinosis associated with folliculotropic mycosis fungoides resulted in follicular disruption and deep dissecting cellulitis. Large‐cell transformation of CTCL was present in the initial diagnostic scalp and axillary lymph node specimens. The patient died from progressive CTCL 9 months following initial diagnosis despite electron beam radiation, topical mechlorethamine, interferon‐α, and systemic chemotherapy. This case indicates that large‐cell transformation of folliculotropic mycosis fungoides is an aggressive form of CTCL, and that folliculotropic mycosis fungoides can give rise to lesions which resemble dissecting cellulitis of the scalp. Upregulation of intercellular adhesion molecule‐1 (ICAM‐1) on follicular epithelium adjacent to lymphocyte function‐associated antigen‐1 (LFA‐1)‐positive folliculotropic lymphoma cells in this report provides insight into lymphocyte homing mechanisms in folliculotropic MF.
ISSN:0303-6987
1600-0560
DOI:10.1111/j.1600-0560.1997.tb01572.x